The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review

Abstract

Study Design: Review. Objectives: To review the current state of endoscopic spine surgery with regard to discectomy, interbody fusion, and combination with Enhanced Recovery After Surgery programs in order to evaluate its relevance to the future of spine care. Methods: A review of the literature and expert opinion is used to accomplish the objectives. Results: The greatest strength of endoscopic spine surgery lies in its adherence to the basic tenets of minimally invasive surgery and its innate compatibility with Enhanced Recovery After Surgery programs, which aim to improve outcomes and reduce health care costs. The greatest challenge faced is the unique surgical skill set and significant learning curve. Conclusions: Endoscopic spine surgery strives to achieve the core goals of minimally invasive surgery, while reducing cost and enhancing quality. In a healthcare market that is becoming increasingly burdened by cost and regulatory constraints, the utilization of endoscopy may become more widespread in the coming years.

Endoscopic Techniques for Lumbar Interbody Fusion: Principles and Context

“…Endoscopic spine operations leave a smaller surgical footprint than the minimally invasive surgeries they build upon and further the advantages of MIS, including reduced tissue disruption, decreased intraoperative blood loss, and shorter hospital admissions [ 5 ]. Moreover, endoscopic surgeries represent a unique contribution in that they may be performed under conscious sedation instead of general anesthesia [ 6 , 7 ], engendering potential improvement in patient satisfaction [ 8 , 9 ]. In the next review article, the authors will discuss the different approaches to LIF and how innovation in endoscopic techniques has driven the learning requirements for these techniques.…”

Expanded Indications of Full Endoscopic Spine Sugery

“…In the last quarter of the 20 th century and early 21 st century, there has been an evident shift from traditional open to minimal invasive spinal surgical techniques (MIS). Endoscopic Spine surgeries (ESS) are also a spectrum of this MIS [1][2][3][4] . In the last ten years, there has been an exponential increase in ESS practice.…”

“…In the last ten years, there has been an exponential increase in ESS practice. It is evolving from individual spine surgeons practice to institutional practice and is getting better incorporated 1,3,[5][6][7] . Now even universities and spine societies are incorporating spine endoscopy in their curriculum and guidelines exemplified by North American Spine Society (NASS).…”

“…This further reduces postoperative pain and incidence of complications. Moreover it increases patient confidence, cosmesis, improved clinical outcomes with quality of life, early ambulation with return to work and reduced length of hospital stay 1,3,5) .…”

Comparative study of the efficacy and safety of minimally invasive interlaminar full-endoscopic discectomy versus conventional microscopic discectomy in single-level lumbar herniated intervertebral disc (ENDO-F Trial): A multicenter, prospective, randomized controlled trial protocol

“…Although technically more demanding, interlaminar full-endoscopic discectomy has signi cantly reduced surgical invasiveness, thereby expanding the indications for endoscopic surgery [5,[8][9][10]. Speci cally, interlaminar full-endoscopic discectomy offers several advantages over conventional microscopic discectomy, including a smaller skin incision, and thus, less scarring as well as less muscle damage, a lower infection rate and volume of blood loss, a less painful recovery, and a shorter hospital stay [3,[11][12][13][14][15][16][17]. Previous studies have reported that there are no differences in clinical outcomes between interlaminar endoscopic and microscopic discectomy [18][19][20][21][22].…”